In the last five years, announcements of Philadelphia hospital closures have filled headlines in the city’s news outlets. The ongoing Black Lives Matter protests around the nation and the COVID-19 pandemic places these recent institutional deaths in stark relief. And although local medical facilities have largely been able to weather the current health crisis, the shuttering of St. Joseph’s Hospital in 2016 and Hahnemann University Hospital in 2019, as well as the proposed end of acute care at Mercy Catholic Hospital in West Philadelphia, all point to a new and dangerous phenomenon in the city: the removal of medical care facilities that predominantly treat Philadelphia’s impoverished residents. In a city of nearly 400,000 living below the poverty line, the Pew Charitable Trust estimates that about 91 percent of these Philadelphians are African American, Hispanic/Latinx, or Asian people of color.

When we pay close attention to the neighborhoods served by these closed, or closing, hospitals, we see that they primarily treated this most vulnerable subset of Philadelphia’s population. A look at the institutional history of Mercy-Douglass Hospital, however, shows that this phenomenon is not new. It is the next phase in a much longer trend of financial struggles and hospital closures that provided care for this same population in the late 19th and 20th centuries. At a moment when citizens around the country are taking to the streets calling for acknowledgement of and action against injustices experienced by people of color, recognition of the systemic factors that caused the closure of Black hospitals in the city is critical to appreciating the modern reoccurrence of this same development.

While some Philadelphians today may remember Mercy-Douglass Hospital at the corner of 50th and Woodland Avenue, two medical facilities preceded this medical institution. Dr. Nathan F. Mossell established the first African American-run hospital in Philadelphia, and the second one in the United States, in 1895. Initially, Frederick Douglass Memorial Hospital and School for Nurses occupied a small, multiple-story building at 1512 Lombard Street and later expanded to include 1532 and 1534 Lombard Street. In 1905, Dr. Eugene Hinson and a group of other black physicians working at Douglass Hospital were unsatisfied with Dr. Mossell’s leadership and founded their own medical care facility. This new institution, Mercy Hospital, opened in 1907 at 17th and Fitzwater Streets and was the second Black-controlled hospital in Philadelphia.

Because both hospitals primarily served impoverished city residents who could not afford to pay for care, they struggled financially. Although they received contributions from women’s benevolent organizations, individual donors, as well as city and state appropriations, funds were routinely tight due to limited cash flow from paying patients. In March 1948, the two hospitals merged to form Mercy-Douglass Hospital in hopes of reducing their respective financial stress and ensuring the existence of one adequate hospital for African Americans doctors, nurses, and patients in Philadelphia. In 1973, however, due to continuing financial problems and limited staff, Mercy-Douglass Hospital closed its doors permanently.

Diving deeply into the changes Mercy-Douglass Hospital and its institutional predecessors experienced between 1895 and 1973 contextualizes the contemporary wave of hospital closures in Philadelphia because it provides historical examples of institutions that faced similar financial problems caused by treating impoverished patients. Like contemporary hospitals in Philadelphia, the challenges faced by Frederick Douglass Memorial Hospital, Mercy Hospital, and Mercy-Douglass Hospital raised questions about adequate healthcare for African Americans, as well as the poor more generally, in the city.

From this history we see that rather than a modern problem, hospital closures are a phenomena that have plagued Philadelphia for decades, causing disruptions in healthcare for people of color and changes to the city’s built environment. After Mercy-Douglass Hospital and its predecessors across the city closed, the former hospital sites became a modern rehabilitation center for patients transitioning to independent living after a hospital stay, a park and recreation center, and a non-profit medical practice that serves underinsured and uninsured patients.

This variation shows that at no point did a hospital replace a closed institution, meaning that patients who relied on large-capacity neighborhood acute care services had to travel farther distances than they did before. As a long-lasting and multidimensional problem, to remedy the city’s healthcare crisis will require long-term solutions, rather than immediate attempts to make space at other large and small healthcare facilities for affected neighborhoods.

Frederick Douglass Memorial Hospital and School for Nurses (1895-1948)

In 1895, Dr. Nathan F. Mossell, the first black physician to graduate from the University of Pennsylvania School of Medicine, founded Frederick Douglass Memorial Hospital and School for Nurses in the heart of the city’s Seventh Ward. As an early institution that helped launch the Black hospital movement, Mossell intended for this hospital to provide adequate medical care to the city’s Black residents. Moreover, in an era when hospitals operated by white doctors excluded Black physicians and nurses, he also wanted to provide space for these professionals to train and establish their careers.

While physical record of Douglass Hospital on the Philadelphia built environment is limited to a state historical marker at 1522 Lombard Street, information about the hospital fills the local written historical record. In his 1951 article on the history of Mercy-Douglass Hospital in the Journal of Negro Education, Elliott Rudwick described the hospital’s first location at 1512 Lombard Street as a “private three story [sic] dwelling.” According to the Philadelphia Inquirer, the layout included a basement dedicated to outpatient care, a second-floor women’s ward with 14 beds, private bed space, and an operating room, as well as a ward for men on the third floor.

In the first year of operation, despite running a deficit of $681.62, the hospital treated nearly 1,000 Black Philadelphians in both the inpatient and outpatient wards with conditions that “ranged from alcoholism to whooping cough.” In that year, five patients died at the hospital, but none of the deaths occurred during the 31 operations. Three women gave birth at the hospital in that year as well.

Through donations from individuals and fundraisers by the Douglass Ladies’ Auxiliary, as well as annual $6,000 appropriations from the state, the hospital survived the first several years of operation while mostly treating patients who could not afford to pay hospital fees. By 1898, increasing numbers of patients necessitated more space, and the hospital expanded to include 1532 and 1534 Lombard Street.

Although Black male physicians led the hospital and performed operations, an important part of Douglass Hospital was the training school for Black female nurses. By 1896, five Black female nurses were in training. Their program included weekly lectures and required courses on massage techniques and “invalid cooking.” In addition to female nurses, the hospital also employed a Black female pharmacist from Howard University.

Despite a group of doctors defecting and establishing Mercy Hospital in 1907, Douglass Hospital thrived in its early years. By 1909, its financials were strong enough to build a new, $100,000 building at 1532 Lombard Street. This success did not last, however. As hospital inspection and standardization increased in the 1920s, Douglass hospital began to fall short of expectations for adequate medical care facilities. At that point, the Philadelphia Federation of Charities removed the institution from its list of approved hospitals and the American College of Surgeons only conditionally approved its certification of the hospital.

Lack of supplies and necessary repairs caused potential patients to avoid the hospital. In 1929, for example, limited donations resulted in a shortage of food for patients. Over a five-year period around this year, the 70-bed facility consistently remained only 40 percent full. The Great Depression compounded these already existing supply and financial problems. Low numbers of patients continued to go to the hospital, and they increasingly could not pay for services. Monetary and material donations slowed to a trickle as well, causing the hospital’s deficit to increase astronomically.

These cycles of challenges caused by limited funds, inadequate facilities, lack of supplies, and low patient numbers caused Douglass Hospital’s reputation to plummet. In 1942, during discussions about merging Douglass Hospital and Mercy Hospital, the Pennsylvania State Board of Medical Education and Licensure removed the hospital from the list of approved institutions to train medical interns. This removal proved to be one of the final nails in Frederick Douglass Memorial Hospital’s coffin. Without the ability to train black physicians, the hospital could no longer achieve one of Dr. Mossell’s original goals for the institution.

Seven years later, after extensive discussions between representatives from Douglass Hospital, Mercy Hospital, and the Community Chest of Philadelphia, Douglass hospital closed as a result of the merger of the two institutions. Due to the disrepair of the building at 1532 Lombard Street, in 1948, the newly merged hospital moved to Mercy Hospital’s location at 50th and Woodland Avenue, officially closing the first Black-controlled hospital in Philadelphia.

Mercy Hospital and School for Nurses (1907-1948)

After over a decade of operation, in 1907, Dr. Eugene Hinson and a group of his fellow Black doctors at Frederick Douglass Memorial Hospital broke away from their original employer and established Mercy Hospital and School for Nurses. Like its predecessor, Mercy Hospital trained and employed Black physicians and nurses. But these leaders believed that their new hospital differed from Douglass hospital because it was more “progressive” in that younger physicians could operate more often than they could under the direction of Mossell.

The structures Mercy Hospital occupied between 1907 and 1948 mirror the evolution of hospitals from small, multi-story buildings to larger complexes. In his history of Mercy-Douglass hospital, Elliott Rudwick describes the first building as “a private dwelling on the Northwest Corner of 17th and Fitzwater Streets” that the group of doctors purchased for $9,900. In the first few years of operation, Mercy Hospital struggled to obtain necessary supplies and money to pay employees. By 1919, however, the hospital’s financial situation and attendance had improved enough that its board expanded the institution by purchasing the Episcopal Divinity School on 50th and Woodland Avenue. With this new acquisition, Mercy Hospital provided over 100 beds for patients and employed more than 50 doctors.

This was the point at which Mercy Hospital and its predecessor began to diverge. As Douglass Hospital’s reputation deteriorated in the 1920s, Mercy Hospital’s remained more positive. Potential patients avoided Douglass Hospital and instead went for treatment at Mercy. When talks of a merger began in the early 1940s, Mercy doctors deplored the idea because of Douglass hospital’s poor reputation, indicating a perceived hierarchy existed between the two institutions. By the end of the decade, despite 71 percent of patients unable to pay for hospital services, Mercy Hospital raised enough money to build a new nurses’ home, power plant, and laundry. Unfortunately, the Great Depression disrupted this success, and like Douglass Hospital, Mercy plunged into financial trouble from which it never fully recovered.

Throughout the 1930s and 1940s, Mercy Hospital continued to struggle financially, just like its counterpart on Lombard Street. It accrued mounting debt, and although physicians on staff resisted discussions about the possible merger between the two institutions, the reality of the two Philadelphia African American hospitals failing to meet basic standards for supplies and facilities resulted in the 1948 merger.

Mercy-Douglass Hospital (1948-1973)

The institutional history of Mercy-Douglass Hospital continued much like its predecessors: a cycle of hope for adequate care and training space for Black patients and doctors, followed by years of decline, and eventual closure. Soon after the merger, the oversight committee chose the Mercy Hospital location at 50th and Woodland Avenue in West Philadelphia for the new hospital’s location. Between May and late June 1948, the Douglass Hospital location on Lombard Street remained opened as the Mercy-Douglass obstetrics division, while 50th and Woodland served as the general hospital. This arrangement did not last, and the Philadelphia Tribune announced the closure of the Lombard street facility on June 29, 1948.

The committee in charge of the merger preferred the Mercy Hospital facility at 50th and Woodland Avenue because it included far more space than the Douglass Hospital location. Not only did this address have a large number of hospital beds, it also boasted a more modern school for nurses, several outbuildings that could be remodeled, and ample grounds for future expansions.

Although 50th and Woodland provided exciting opportunities for future expansion, the first director of Mercy-Douglass, Dr. Wilbur B. Strickland, a Black physician who spent part of his career as a hospital administrator for the United States Army, inherited the challenges of the new hospital’s predecessors. Just after the merger, Mercy-Douglass lacked sufficient oxygen, blood, and medications to treat patients. By remedying these shortages and implementing structures such as increasing staff efficiency and adding departments that would increase revenue, he hoped to ensure the hospital’s long-term success.

Despite Strickland’s goals, as well as those of his successors, Mercy-Douglass remained in financial distress. Elliott Rudwick believed that the root of the problem was that the hospital treated far too many patients who could not pay hospital fees. With 82 beds available in the public ward and just 22 beds available in private and semi-private rooms, he argued that patients with the financial means to pay for treatment turned away in favor of hospitals that offered more privacy and less “charity.”

The Philadelphia Tribune’s July 1973 headline announcing the closure of Mercy-Douglass Hospital reiterated the financial problems that plagued the institution. The headline read “Money Problems, Lack of Doctors, Nurses Force Mercy Hospital to Close,” and thus pointed to the consistency with which financial and staffing problems troubled the hospital and its predecessors. The article also referred to the merger as a “shotgun wedding,” indicating that it may have been ill-advised and doomed from the start due to existing problems each of the former institutions brought to the merged hospital. Despite this rather critical stance towards Mercy-Douglass and the challenges that caused it to close, the Tribune lamented the shuttering of the city’s only Black hospital. It called the moment a “sad day for the Philadelphia Black Community” and the closure the “death rattles of former, proud Black citadels of mercy.”

The Legacy of 20th Century African American Hospital Closures

The closure of Mercy-Douglass Hospital in 1973 ended the tumultuous history of this institution and its predecessors, Mercy Hospital and Frederick Douglass Memorial Hospital. From this institutional history we gain a window on the successes and challenges faced by Black-controlled hospitals from the late-19th to the mid-20th century. Each of these stories allow us to see how Black doctors and nurses established and operated care facilities for African American patients in a period when pervasive racism may have prevented them from receiving adequate treatment in white-run hospitals. We also see the strong emphasis African American hospital administrators placed on creating space for Black doctors and nurses to train when they were denied such opportunities in white-run hospitals.

But the stories of Douglass Hospital, Mercy Hospital, and Mercy-Douglass Hospital are as tragic as they are illuminative. They show us that financial difficulties caused by treating impoverished patients of color led to their demise. Cycles of supply shortages, inadequate facilities, debt, and closures plague this history. These stories illustrate that without the resources of and association with the contemporary hospitals of the University of Pennsylvania, for example, Mercy-Douglass could not survive.

What do these 20th century hospital closures teach us about modern closures of St. Joseph’s Hospital, Hahnemann Hospital, and Mercy Catholic Hospital? Each of these three hospitals that have closed or will likely close predominantly treated poor communities of color. Their removal caused or will cause shifts in if and where these communities receive acute care. The 20th century closures teach us that this phenomenon is not new. When the Frederick Douglass Memorial Hospital building on Lombard Street closed in the summer of 1948, patients who lived in the vicinity of the hospital made this same shift. Again in 1973, patients in the vicinity of 50th and Woodland were suddenly without access to healthcare in their neighborhood.

In this particular moment when the international COVID-19 pandemic bears down on the city and Philadelphians join national protests calling for racial justice, the closure of contemporary local hospitals is especially striking. When citizens across the city recognize the long-term impacts of systemic racism, empty space in Hahnemann sits unused while other hospitals strive to meet the needs of impoverished patients. This moment shows the dangerous consequences of eliminating the city’s medical care facilities.

But the current crisis should not distract one from the long history of hospital closures in the city. As the institutional histories of Mercy-Douglass Hospital and its predecessors show, Philadelphia has experienced hospital closures in critical areas for decades. The historical roots, then, mean that a solution must address systemic factors that cause, and have caused, these institutions to close, rather than only on temporary adjustments to ensure affected populations receive the care they need in the immediate future.